subject: Common Treatments for Bulimia [print this page] Common Treatments for Bulimia
Bulimia nervosa was first recognised by medical experts 30 years ago and is believed to affect between 0.5 per cent and 2 per cent of people. People with bulimia feel trapped into a cycle of binge eating then purging the body of the unwanted food by vomiting, use of laxative and sometimes over-exercising. Sufferers feel a great deal of shame about their behaviour and so bulimia often remains a secret disorder. Many do not share their problem with friends and family and are alone with the harmful cycle of bulimia. People tend to develop bulimia during their late teens and early twenties, although the disorder can persist or emerge later in life.
On a more positive note, however, bulimia is a condition which responds well to treatment. For people with mild bulimia, a self-help programme can work well, provided the programme has been written by medical experts specialising in the treatment of eating disorders. For example, Professor Hubert Lacey, one of the UK's foremost expert in eating disorders, has recently published 'Bulimia and Binge-eating and their treatment' http://www.sheldonpress.co.uk/books/9781847090355.html. However people with a more severe form of bulimia will need to see a professional to direct their treatment programme.
Treatment for bulimia normally takes place on an outpatient basis, which means the individual sees a professional (psychiatrist or psychologist) every week for an hour of talking therapy. It is fairly rare for people with bulimia to need inpatient treatment. Those who need to be admitted to stay within an eating disorders centre for their treatment would tend to have other difficulties such as self-harm, or a very severe form of bulimia which has a particularly adverse affect upon their overall health. To access this treatment, it is best to see your GP and discuss your eating disorder. Your GP will be able to refer you to specialist services within your area.
Established treatment offered by recognised eating disorders centres is based on ideas taken from Cognitive Behavioural Therapy (CBT). This is a form of psychological treatment which explores the relationship between thoughts, feelings and behaviour. People with bulimia often say they binge when they are unable to control negative feelings about themselves, perhaps triggered by stress or life changes. CBT is a practical approach which helps sufferers to cope better with their feelings and in doing so, change their pattern of thoughts and behaviour.
At the start of a programme of treatment, an approach called Motivation Enhancement Therapy (MET) is often used. The principle of MET is to help understand the function an eating disorder has for the individual and harness their personal motivation to affect change. People with bulimia often feel deeply ashamed of their eating pattern but are unable to break the cycle. A simple MET exercise would involve writing down what you see as the advantages and disadvantages of the eating disorder. You should also consider possible barriers to change. For example, people with bulimia often fear that overcoming the disorder would lead to weight gain. In fact, self-induced vomiting only rids the body of 30 per cent of consumed calories and for laxatives, the loss is only 10 per cent. These behaviours increase the risk of binge eating, so overall people with bulimia tend to stay at the same weight or even gain gradually over time. It is very rare for there to be significant weight gain after bulimia is effectively treated.
The next stage of treatment is to consider eating patterns and the specific risks around bingeing. For example, the individual may be asked whether binges tend to take place in a particular location or at specific times, what tends to be happening in daily life around the time of the binge and does the individual restrict food intake before a binge. Careful and thorough recording of food intake, feelings, thoughts and behaviour is very important.
Introducing a regular pattern of regular eating is an key aspect of treatment. A technique called mindfulness, used extensively in the treatment of depression, can be very useful. The concept of mindfulness developed from the observation that a seemingly minor situation or change of mood can trigger overwhelmingly negative feelings. For example, a person with bulimia could take her children to school, believe another mother failed to say 'hello', return home feeling increasingly low then subsequently binge. Mindfulness refers to developing the ability to respond in a different and more aware way to a negative situation, rather than going into 'autopilot'. Becoming more aware of our thoughts, feelings and body sensations that are triggered by events opens up the possibility of responding to challenges in a different way.
The treatment programme will help the individual to develop problem-solving skills and techniques tailored to their binge-eating pattern to help them overcome the cycle. The individual is encouraged to see these techniques as life skills which are, at first, challenging to put into practice but will over time feel more instinctive. At the end of the treatment programme, the individual may be encouraged to write a letter to him/herself, describing the changes they have made and how they feel about the changes. A relapse plan may be drawn up with clear strategies for dealing with risks and triggers for bulimia developing again.
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